Diagnosing rural health with NRHA past president Beth O’Connor (part I)
In this two-part series, Misch and O’Connor discuss the developing nature of rural health care, some of its most pressing challenges, and how MEDHOST collaborates with rural health systems to continue serving their needs.
The first section of this interview emphasizes the challenges of connectivity, population health management, and the impact COVID has had.
KM: Thank you for joining us today, Beth. Can you start by telling me a little about your current role and why you’re so passionate about rural health?
BO: I’ve been the executive director of the Virginia Rural Health Association for the past 17 years. Through that role, I became involved in the National Rural Health Association, serving in several positions including president of the board of trustees.
My passion for rural health comes from growing up in rural Minnesota and being concerned about the welfare of my family, friends, and neighbors.
KM: You've been a rural health advocate, as you said, for 17 years. What kind of new challenges have you seen emerge in that time?
BO: One is that technology has an increasing influence in our lives and in health care. It has become both a way to bridge the rural-urban gap and a contributor to that gap. We can use technology to provide better access to many health care services, but only where broadband is available.
For instance, I’m having this conversation from my office, partially because there is no way I could do it from my home.
The other is the concept of population health management. Public health researchers have learned that health outcomes have more to do with where you live than how you live. We can estimate someone's life expectancy based on their zip code.
The challenge is how to address those health inequities. The burden of doing so, for the most part, has been placed on local hospitals, which isn't something these facilities were ever designed to address.
Finding a way forward and addressing population health will be a big challenge for rural hospitals in the future.
KM: COVID-19 changed the dynamic of our industry and highlighted several needs and wants. What would you say are the biggest lessons you learned during the pandemic, particularly as it relates to rural health care?
BO: Over the years, I have seen a decreasing level of trust in health care providers. Generations ago, the country doctor was an icon of the community. Now, we see people more willing to believe something they read from an unsubstantiated source on the internet than the advice of their primary care provider.
COVID taught us that mistrust in health care systems has very real consequences. Before, if someone didn't follow the advice of their doctor, it was their problem. But with an infectious disease, it becomes everyone's problem very quickly.
KM: What is happening with telehealth in rural communities? COVID-19 seemed to cause a spike, but recent data indicates that it has dropped off significantly.
BO: Restrictions on in-person care increased the use of telehealth. But more importantly, so did removing the regulations on using telehealth. Congress put in place several provisions that increased the ability of rural providers to serve their patients in a virtual setting.
Unfortunately, those provisions were temporary and ended as soon as the public health emergency was been declared over.
What we need Congress to do at this point is pass legislation to reduce those barriers permanently. No one is going to invest time and resources in a program that could have its reimbursement ended at any minute.
KM: Do some providers view telehealth as a new form of competition?
BO: Yes and no.
It would very much depend on the provider. A rural primary care provider most likely isn’t going to be replaced by telehealth. But a rural specialist—maybe so.
In truth, we already have so few specialists in rural communities, I don’t think that’s a serious consideration at this time.
KM: Workforce development in rural health care, including health care IT experts, has emerged as a critical challenge during the pandemic. What are some of the biggest callouts that you see arising from that, and how do you think they should be resolved?
BO: COVID had really brought to light the lack of every health care position, whether that’s nurses, phlebotomists, or IT staff.
Looking at what we can do to address that in the future, I see two things:
One, make the cost of receiving an education more manageable. When I attended the International Rural Health Conference in June, the question I was asked most often by people from other countries was, “Is it true that students go into huge debt in the United States?”
We must find a way to address student loan debt to make sure people can get a quality education without going thousands of dollars in debt.
Two, we need to improve our working environment. Too often employees are treated as interchangeable parts instead of valuable individuals. The percentage of pupils that go into nursing school but leave the field in less than five years is, frankly, a national source of embarrassment.
Until we treat people with respect and pay them in an equitable manner, nothing will change.
In part II, where Misch and O’Connor touch on social determinants of health, interoperability, the ongoing crisis of rural hospital closure, and more.
NRHA adapted the above piece from MEDHOST, a trusted NRHA partner, for publication within the Association’s Rural Health Voices blog.